The relationship between suture number and the healing process of end-to-end arterial anastomosis

Abstract

In spite of the grate experience accumulated in vascular repairing, the ideal number of sutures for vascular anastomosis remains controversial. It is generally thought that the more stitches applied in a vascular anastomosis, the lesser resistant the anastomosis will be. The purpose of this study was to test this hypothesis in 20 rabbits, in which both carotid arteries were cross sectioned and repaired by end-to-end anastomosis with 8 interrupted sutures in one side (G1) and 16 in the other side (G2). After 3 and 15 days, the animals were randomly allocated for tensile strength, hydroxyproline determination (7 animals) and for histologic analysis of the anastomosis (3 animals). Conventional staining procedures (hematoxylin-eosin and Masson methods) and the picrosirius red polarization (PSP) technique for collagen type determination were used. From 3 to 15 days, the tensile strength increased in both groups, from 265.0±-44.4g to 391.2±-49.0g in G1 and from 310.0±-71.5g to 348.7±-84.0g in G2 (p<0.005), with no statistical difference between the groups in each period of study. The hydroxyproline content, expressed as hydroxyproline/protein ratio, varied from 0.04±-0.01 to 0.05±-0.02 in G1 and from 0.05±-0.01 to 0.05±-0.02 in G2, with no significant difference between periods and groups. The histology showed similar inflammatory and reparative aspects in both groups. In both groups and periods the PSP technique demonstrated predominantly type I collagen in relation to type III collagen in the anastomosis. We concluded that even doubling the number of stitches, the healing process and strength did not change in the arterial anastomosis

A polyurethane‐based surgical adhesive for sealing blood vessel anastomoses—A feasibility study in pigs

“…A mild to moderate inflammatory local tissue reaction to the adhesive and the presence of granulocytes, macrophages and the formation of connective tissue at the tissue‐adhesive interface were in line with physiological biomaterial interaction 27 . Inflammation of the inner vessel wall structures (sometimes with mild necrosis), was most likely a consecutive consequence of the damage from cutting, suturing and resulting tension in sutured areas 28 . Proliferative activity within the vessel starts shortly after tissue damage and is an integral part of the repair process to bridge the anastomosis 29,30 .…”

“…In microsurgical settings, a lower stich number is favorable because it induces less vessel wall injury which is likely to favor long‐term patency 20,30 . Authors are divided whether this is the case for non‐microsurgical settings 3,28 . Nevertheless, this approach will reduce ischemia time due to quicker anastomosis creation and yields higher practicability especially in hard‐to‐reach areas.…”

“…27 Inflammation of the inner vessel wall structures (sometimes with mild necrosis), was most likely a consecutive consequence of the damage from cutting, suturing and resulting tension in sutured areas. 28 Proliferative activity within the vessel starts shortly after tissue damage and is an integral part of the repair process to bridge the anastomosis. 29,30 However, excessive intimal hyperplasia as well as thrombi can lead to stenosis.…”

Needle-to-suture ratio, as well as suture material, impacts needle-hole bleeding in vascular anastomoses

“…The number of needle holes used in each anastomosis was recorded in the data sheets. It was attempted to have a 1 mm space between each needle hole [5]. The number of needle holes was used to calculate the needle-hole leak rate for each anastomosis.…”

Non-aqueous, tissue compliant carbene-crosslinking bioadhesives

“…The ability of sutures and staples [1,2] to rapidly fix tissues prevails over their complications of inflammatory response, scar tissue formation [3] and secondary operations. [4,5] Current innovations have focused on bioresorbable materials, mechanical architectures (e.g. barbed), surface coatings [6] and alternative methods of application.…”